Etiology of Liver Patterns

Emotions

According to Five Element theory, anger and other related emotions such as resentment, unfulfilled desires, frustration, etc. are attributed to the Liver. The relationship between an organ and its corresponding emotion is reciprocal. The Liver for instance, is responsible for the free and smooth flow of Qi, which has a deep relationship with a person's emotional state. Conversely, anger, repressed emotions, etc. affect the Liver organ itself, and disrupt the smooth flow of Qi in the body.

If Liver is functioning well, and its Qi is flowing smoothly, the emotional state will be happy, and "relaxed" or "free and easy". Emotions will be freely expressed. When Liver Qi does not freely flow, stagnation of Qi occurs, and affects the emotional state. This causes anger and irritability. Over a long period of time, stagnation of Liver Qi impairs circulation of Qi and can cause emotional states of constant low level anger, depression, and resentment. These may be transferred to and appear in the physical body, such as the chest, breasts in women, hypochondriac region, epigastric region, or throat. Stagnation of Liver Qi, therefore, produces feelings of tightness in the chest and hypochondriac region, often with frequent sighing, pain and swelling of the breasts, tension in the stomach, the sensation of a lump in the throat.

Liver Qi may "rebel" upward and cause Liver Yang to rise. Symptoms include irritability, headaches, and the propensity to lose one's temper.

Diet

Excessive greasy and hot foods can cause Liver Fire. Examples of hot foods are lamb, beef, curry, and other spices. Examples of damp or greasy foods are deep fried food, and alcohol.
Not enough warming foods, such as meat and grains, can contribute to inadequate Blood production and Blood Deficiency.
Blood Deficiency, in turn, can lead to Liver Blood Deficiency. Women are particularly prone to Blood Deficiency especially at puberty, after childbirth, and somewhat after each period.

Liver Qi Stagnation

Signs:

Distention and pain in the chest and hypochondriac region
Areas coursed by the Liver channels

Frequent sighing
Releasing Stagnant Qi in the chest

Depression, moodiness, melancholy, unhappiness, and a general tense feeling
Flow of Liver Qi affecting the emotions or vice versa

Sensation of a lump in the throat with trouble swallowing
Internal branch of the Liver channel ascends along the neck and throat

Tongue

Normal tongue body

Pulse

Wiry pulse

Notes

This is an extremely common pattern. Wide range of symptoms, which typically fluctuate considerably in proportion to the amount of stress the person feels. the patient will have periods of depression with worsening of physical symptoms, and times when symptoms improve. Women during the premenstrual time are naturally more prone to stagnation-related problems, since at this time Blood is collecting in the uterus and Qi levels are diminishing.

Stagnation of Liver Qi over a long time induces stasis of Liver Blood

Etiology/Pathology

Emotional disharmony, especially repressed anger, resentment, frustration, over a long time, which impairs the circulation of Liver Qi.

Treatment Principle

Disperse the Liver and regulate Qi

Points

LIV-3 (Taichong)
Regulates Liver Qi and especially effective when the throat is involved

TaiYang (Extra Point)
Subdues Liver Yang, local point for headache on temple

GB-20 (Fengchi)
Subdues Liver Yang, use as local pt for headache in occiput or headache around eye

GB-9 (Tianchong)
Subdues Liver Yang, important local points for headaches on the lateral aspect of head

GB-8 (Shuaigu)
Subdues Liver Yang, important local points for headaches on the lateral aspect of head

GB-6 (Xuanli)
Subdues Liver Yang, important local points for headaches on the lateral aspect of head

Method

Sedate points that subdue Liver Yang

Tonify points that nourish Yin

Notes

This both an excess and deficient pattern. The excess being the Rising Liver Yang and heat, the deficiency usually being that of Liver Yin and/or Kidney Yin. In Five Element theory, Water fails to nourish wood.

Difference between Liver Fire Blazing Upwards and Liver Yang Rising:

Liver Fire Blazing is a true Excess pattern where it produces Excess Fire that dries up Body Fluids and causes signs of Dryness, such as constipation, red eyes, scanty and dark urine, bitter taste, etc. Liver Yang Ascending does not have full Heat signs because the excess is due to deficiency

Cold Stagnation in the Liver Channel

Signs

Fullness/distention of hypogastric region, pain in the scrotum/testes
Cold in the Liver Channel

Straining of testes or contraction of scrotum
Cold in the Liver Channel

Method

Sedate. Moxa is applicable

Damp-Heat in the Liver and Gallbladder

This pattern is a combination of Heat in Liver and Dampness in Spleen.
There must be Dampness in Spleen for the pattern to manifest.
Dampness in Liver and Gallbladder channel causes Liver Qi to stagnate by obstructing the smooth flow of Liver Qi. This results in distention/pain of hypochondrium and chest. Then the Liver Qi invades Stomach, with symptoms such as (nausea, vomiting, loss of Appetite and abdominal distention.

Accumulation of Dampness can obstruct the flow of bile and cause jaundice.

Damp-Heat causes low grade continuous fever

Dampness can flow down and settles in Lower Burner and give rise to symptoms such as vaginal discharge and itching or pain/swelling and redness of scrotum

Signs

Fever, Bitter taste
Presence of Heat

Scanty dark urine
Damp and heat obstructing

Fullness/pain of the chest and hypochondrium
Dampness causing Qi to stagnate

External:
Invasion of exogenous Damp-Heat.
Common in tropics, less common in temperate climates.

Treatment Principle

Resolve Dampness, Clear Heat,
Disperse Liver and Gallbladder

Points

LIV-14 (Qimen)
Regulates Liver Qi in hypochondrium/epigastrium

GB-24 (Riyue)
Regulates Liver Qi, soothes Gallbladder, Resolves Damp

GB-34 (Yanglingquan)
Move stagnant Liver Qi and resolve Dampness

BL-18 (Ganshu)
Move stagnant Liver Qi and resolve Dampness

BL-19 ( Danshu)
Move stagnant Liver Qi and resolve Dampness

DU-9 (ZhiYang)
Resolves Dampness from Gallbladder

REN-12 (Zhongwan)
Tonifies Spleen to resolve Dampness

SP-9 (Yinlingquan)
Resolve Dampness in Lower Burner

SP-6 (SanYinjiao)
Resolve Dampness in Lower Burner

SP-3 (Taibai)
Resolve Dampness

LI-11 (Quchi)
Clear Heat, resolve Dampness

LIV-2 (Xingjian)
Clear Heat in Liver

Method

Sedate all points except REN-12, which is tonified to tonify Spleen

Gallbladder Patterns

Gallbladder Functions:

Stores bile. The Gallbladder's job of storing and emptying the bile is dependent on the Liver ensuring the smooth flow of Qi. The Gallbladder is easily affected by Dampness deriving from an impairment of the Spleen function of transformation and transportation.

Etiology/Pathology:

Diet: excessive consumption of greasy and fatty foods leads to the formation of Dampness which can lodge in the Gallbladder.

Emotions: Anger, frustration and bottled-up resentment can cause stagnation of Liver Qi which, in turn, can produce Heat which affects the Gallbladder. Pent up anger over a long period of time implodes to give rise Fire in Liver and Gallbladder with symptoms of irritability, bitter taste, thirst, headaches, etc. Gallstones can be seen as the manifestation of "Gall"- Liver Qi stagnation here.

Climate: Exogenous Dampness and Heat, as found in tropical or subtropical regions, can cause Damp-Heat in the Gallbladder. (Impairs the Spleen's function of transforming and transporting, deficient Spleen Qi creates many Gallbladder problems. Dampness lodges in the Gallbladder and gets stuck.)

Notes

Only Yang organ that doesn't deal with waste

Doesn't communicate with the external environment

Doesn't revive or transport

Called the curious organ

Receives bile from liver, stores in GB and secrets in on demand from Liver

Controls sinews with Liver

Mobility, agility

Controls Decision making

Courage, initiative

GB XU=indecisiveness, easily discouraged=GB40

Too timid to have dreams and ideas or at first stumbling block give it up

Damp-Heat in the Gallbladder

Clinical Manifestations

Hypochondriac pain and distention: (Dampness in the GB interferes with the smooth flow of LV Qi which stagnates and causes hypochondriac pain and distention, usually starts in front and radiates around to B18 or 19).

Thirst without desire to drink (the thirst is heat, without the desire is dampness)

Bitter taste: (Liver Heat)

Tongue

Thick-sticky yellow coating (esp. on Right side), either bilateral or only on one side.

Pulse

Slippery and wiry pulse

Differentiation from Damp-Heat in Liver/Gallbladder=More pain after eating and inability to digest fats-pain radiating to the back (nausea, vomiting, jaundice). This is a sub-category of Damp-heat in the Liver/Gallbladder.

Pathology

Pure excess. UnderlYing Spleen Qi Deficiency leading to the formation of Dampness which obstructs the GB-damp always obstructs the flow of Qi.

Etiology/Pathology

Excessive consumption of greasy and fatty foods leads to formation of Dampness which combines with the Heat.

Exogenous Damp-Heat-in tropical or subtropical regions.

Treatment Principle

Resolve damp, clear heat in the Gallbladder, smooth the flow of Liver Qi

Method

Reducing (except Ren12 and UB20)

Points

GB-24 and UB-19
Front Mu and Back shu, clear heat in the GB, good for acute stage

LIV-14 and BL-18
Clear Heat in the Liver

REN-12 and BL-20
Resolve dampness

Dannangxue (Extra point)
Special point slightly below GB34) Stimulates the smooth flow of Liver Qi. Resolves Dampness and Clears heat. (Only used if tender on pressure-choose between this and GB34).

DU-9
Clears Heat in the GB, stimulates the smooth flow of Liver Qi and Resolves Dampness

LI-11
Clears Heat and resolves Damp.

SJ-6
Stimulates the smooth flow of Liver Qi and Clears Heat in the Shao Yang channels. GB24 to 34 with electricity can stop a GB stone attack-Very well treated
If in acute phase, get them on herbs, off rich food, hook them up to electro-acupuncture. Can get fever in very acute phase.

Western Conditions

Three kinds of Gallstones:

Calcium, which are white and hard

Cholesterol, which are soft and green

Combined

Gallbladder Deficiency

Clinical Manifestations

Dizziness

Blurred vision

Nervousness

Timidity

Propensity to being easily startled

Lack of courage and initiative
Weakness of the Hun, Liver not housing the Hun. Deficiency of wood that manifests more as fear than anger.

Sighing

Tongue

Pale or normal tongue

Pulse

Normal, possibly weak

Pathology

This is Deficiency
Yang aspect of liver. Should give you the energy to face the world. Makes up for lack of a liver Qi Deficiency syndrome
Often combined with Liver Blood Deficiency

Etiology

None
Severe Deficiency of Blood may result in fear (esp. on going to bed at night) and lack of courage. Blood and Yin are the root of the Ethereal Soul (Hun).
Childhood wounding, abuse, repressed anger, kid who was always ridiculed

Treatment Principle

Tonify and warm the Gallbladder

Method

Reinforcing and Moxibustion if there is no heat

Points:

GB-40
The Source point the tonify the Gallbladder, and it has a good effect on this particular mental aspect of the Gallbladder.